Inspection on 06/11/07 for Granary The

This inspection was carried out on 6th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granary The 17/05/07

Granary The 24/11/05

Granary The 13/06/05

Granary The 04/11/04

Granary The 07/06/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Granary The Church Lane Brandesburton Driffield East Yorkshire YO25 8QZ Lead Inspector Christina Bettison Key Unannounced Inspection 6th November 2007 09:30 DS0000019742.V354273.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000019742.V354273.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000019742.V354273.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Granary The Address Church Lane Brandesburton Driffield East Yorkshire YO25 8QZ 01964 543332 01964 543332 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) londonroad@tiscali.co.uk Milbury Care Services Ltd Jacinta Murray Care Home 15 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (4) of places DS0000019742.V354273.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC; To service users of the following gender: Either; Whose primary care needs on admisson to the home are within the following categories: Learning disability - Code LD and LD(E) The maximum number of service users who can be accommodated is: 12 Category LD(E) relates only to named service users identified to the Commission for Social Care Inspection on 18.9.2006. 17th May 2007 2. 3. Date of last inspection Brief Description of the Service: The Granary is a care home providing accommodation and care for up to 12 adults with learning disabilities. It is located in the village of Brandesburton. It is a short walk into the village and allows access to hairdressers, shops, post office, pubs and a fish and chip shop. The main road through the village allows access to public transport. The home was opened in 1990. There are 12 single bedrooms, three of which have en-suite facilities. The home has a wellmaintained front garden and is surrounded on two sides by fields. Garden furniture is available for service users to sit outside. All bedrooms are for single occupancy. Weekly fees are: £680 - £985 per person. Additional charges are made for the following: newspapers/magazines, hairdressing, chiropody, transport for social activities and sweets. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. DS0000019742.V354273.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an announced key inspection and took place over 1 day in November 2007. Relatives surveys were posted out of which 5 were returned, 2 visiting professional surveys were returned. 10 easy read surveys were returned from the people that live in the home. During the visit the inspector spoke to the area manager, senior staff and one support worker who was on duty at the time of inspection. Most of the people who live in the home were out at the time of the visit and two people were in the hospital however the few that were in were seen and one person was spoken to at length. Interactions between staff and the people who live in the home were observed to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at some records. Millbury care services managers and CSCI have been meeting on a monthly basis to review the progress being made to improve the standards at the home, information received at the meetings and other information received over the last six months was considered in forming a judgement. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past six months and the completed annual quality assurance assessment, which was completed very comprehensively. The site visit was led by Regulation Inspector Mrs. T. Bettison, the visit lasted seven hours. What the service does well: The people who live in the home and their relatives are provided with information that is easy to read so that they know what to expect from the home. The home is situated in a friendly quiet village where the people who live in the home are accepted and included in village and community life. Everybody has a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. DS0000019742.V354273.R01.S.doc Version 5.2 Page 6 Relatives are involved in the home and are made to feel welcome, making sure that family can keep in contact. A good recruitment policy is in place so that people are protected from harm. The people who live in the home say they are very happy living there, ten people completed the CSCI questionnaire and there were no negative comments about the home, one commented “I ask staff to help me” and another stated “ I like being here, I enjoy living here lots of friends including staff” and another said “ I keep my house clean”. Comments received from visiting professionals included “the two people I placed were made in an emergency however staff did everything possible to gather as much information as possible prior to admission to ensure they could meet the individual needs”, “if there are difficulties with an individual they (staff) readily seek advice and support from other professionals” “a very good service” And a relative commented “as long as the staff remain as caring as at present I would find it difficult to suggest any improvements” and another stated “my son is happy there, he gets on well with all staff members” and another said “they care for my son extremely well and I can only praise them for the care the give”. What has improved since the last inspection? At the previous inspection it was noted that most of the people have lived in the home for a number of years and have been cared for by the same group of staff. The new manager and the company recognised that they needed to change in a number of ways. Milbury care services and CSCI have been working closely together and meeting regularly to review progress and it was noted at this inspection that significant improvements have been made. Managers and staff have worked very hard to improve standards in the home and to meet or partially meet the requirements made at the previous inspection. All of the people that live in the home are in the process of being re assessed/reviewed by the placing local authority to ensure that the home can still meet their needs and that the funding is correct and the right amount of staff can be provided to meet peoples changing needs. Two of the care files have been completely re written and include service users plans, health plans, risk assessments and plans for managing difficult behaviour. These are much more detailed to give staff clear instructions in how to meet people’s complex needs. However these improvements need to continue to ensure that all of the care files reach the same standard. DS0000019742.V354273.R01.S.doc Version 5.2 Page 7 The staff are now keeping much better records of outcomes for people that live in the home so that everyone can be assured their needs are being met. When people that live in the home have periods of ill health this is being managed better and health professionals are consulted and health services provided. This could be evidenced better by improving the recording methods used by the staff. The senior member of staff responsible for monitoring training has a good understanding of what training has been provided and what still needs to happen in respect of training. Most staff are now up to date with their basic training, staff that needed it have completed induction training, all of the staff who give people medication have all received training and have been assessed as competent by the home manager and some special training has been provided and more is planned. Equipment and services in the home have now all been maintained and serviced regularly to ensure that the home is safe for the people who live there. What they could do better: The process of all of the people that live in the home being re assessed/reviewed by the placing local authority must continue to ensure that the home can still meet their needs and that the funding is correct and the right amount of staff can be provided to meet peoples changing needs. Two of the care files have been completely re written and include service users plans, health plans, risk assessments and plans for managing difficult behaviour. These are much more detailed to give staff clear instructions in how to meet people’s complex needs. However these improvements need to continue to ensure that all of the people have a plan and all of the care files reach the same standard. All of the peoples religious and cultural needs and activities and interests will need to be included in their plans. There needs to be enough staff in the home that are trained in how to meet the complicated needs of the people that live in the home and to make sure that the staff carry out all of their duties safely. A visiting professional commented, “More staff on duty would be beneficial. This is a high cost placement and staffing doesn’t appear to be as high as one would expect from such a placement” And a relative commented, “additional staff would be welcome but the current carers are to be commended for the manner in which they perform demanding tasks”. DS0000019742.V354273.R01.S.doc Version 5.2 Page 8 A relative commented “it might be an idea to have some sort of newsletter just to let friends and family know what is going on and how people are doing, it could be a one month thing” Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000019742.V354273.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000019742.V354273.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are assessed prior to admission and the re assessment/review of peoples changing needs that is currently taking place should ensure that the home is sufficiently resourced in the future to meet their needs. EVIDENCE: The home has a statement of purpose and service users guide, and the people that live in the home and their representatives are provided with information about the home. Since the previous inspection the service users guide and resident agreement has been reviewed and amended to state that Milbury care will make a contribution towards a holiday or a series of one day outings and that people will make a contribution of £8.00 towards transport. The holiday contribution is set at £200 per year and the manager and senior staff are aware of this. We were informed that the placing authorities have agreed to this within their contracting arrangements. DS0000019742.V354273.R01.S.doc Version 5.2 Page 11 At the previous inspection there had been two new admissions to the home. Both people had a copy of the community care assessment and Local Authority care plan on file. In addition to this the home had completed their own assessment. Since that inspection for one of the people all of the assessed needs have been developed into a very detailed service user plan, with accompanying behaviour management guidelines, risk assessments and better recording of outcomes. This progress needs to continue to ensure that the other new person has a plan and supporting documentation to the same standard. Both of the new admissions were placed as emergency placements therefore Milbury and Voyage had little control over the arrangements for introduction to the new service. Comments received from visiting professionals included “the two people I placed were made in an emergency however staff did everything possible to gather as much information as possible prior to admission to ensure they could meet the individual needs” “if there are difficulties with an individual they (staff) readily seek advice and support from other professionals”. Consideration has now been given as to whether the home is sufficiently resourced to meet everyone’s needs. All of the people that live in the home are in the process of being re assessed/reviewed by the placing local authority to ensure that the home can still meet their needs and that the funding is correct and the right amount of staff can be provided to meet peoples changing needs. We were also informed that both of the people who are currently in the hospital will be re assessed prior to them coming home to ensure that the home can continue to met their changing needs. DS0000019742.V354273.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples needs are assessed prior to admission and the re assessment/review of peoples changing needs that is currently taking place should ensure that the home is sufficiently resourced in the future to meet their needs. Peoples needs are generally met and the quality of the service user plans are much improved however this needs to be maintained to ensure that peoples changing needs continue to be met. EVIDENCE: At the previous inspection it was noted that service users plans and supporting documentation were of an unacceptably poor standard. This was accepted by managers of Milbury care services and since that inspection managers and staff have been working very hard to improve the quality of the paperwork. DS0000019742.V354273.R01.S.doc Version 5.2 Page 13 However this has been hampered by the fact that half way through the process of transferring care files over to a new system, Milbury care brought in a new corporate format and all of the care plans had to be transferred yet again. In addition to this in June of this year the home suffered from extensive flooding when the region was hit by unprecedented amounts of rainfall. We were informed that out of twelve care files, two care files, service user plans and supporting documentation had been completed, one has been half completed and the remaining nine need to be completed. Three of the care files, plans and supporting documentation were examined as part of the site visit and the one care file that had been completed in full was much more informative and detailed. It included all of the information required by regulation and NMS 2.2 and further information relating to decision making, aging, death and illness, nutritional screening and all of the care plan areas signposted to a risk assessment or support plans or both. It was of an excellent standard. In addition this person is currently in hospital however it was clear to see from the recordings how this had come about and how the support of health professionals had helped. However the other two care files examined were not of such a good standard, this was discussed with the area manager who accepted for the reasons stated above that progress had been delayed however they would be making a real attempt to complete all of the care files and plans to the same high standard as soon as possible. Recordings of outcomes for the people was much improved. Re assessment of all of the people living in the home is currently taking place and reviews are now being held every 6 months. Notes of the reviews were seen on files. Overall significant improvements were noted and this work must continue to ensure consistency across the service. DS0000019742.V354273.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 16 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A range of activities within the home and community means that people that live in the home have the opportunity to maintain and develop their skills and participate in stimulating and motivating activities that meet their individual needs, wants and aspirations, this will be further improved by better planning, recording and additional staffing. EVIDENCE: At the previous inspection it was noted that service users plans and supporting documentation were of an unacceptably poor standard. This was accepted by managers of Milbury care services and since that inspection managers and staff have been working very hard to improve the quality of the paperwork. DS0000019742.V354273.R01.S.doc Version 5.2 Page 15 However this has been hampered by the fact that half way through the process of transferring care files over to a new system, Milbury care brought in a new corporate format and all of the care plans had to be transferred yet again. In addition to this in June of this year the home suffered from extensive flooding when the region was hit by unprecedented amounts of rainfall. We were informed that out of twelve care files, two care files, service user plans and supporting documentation had been completed, one has been half completed and the remaining nine need to be completed. People that live in the home are being provided with a range of activities, both in-house and within the community however because of the delays in ensuring everyone has an up to date plan there was still little evidence that peoples needs in this area had been identified, planned for and therefore met. People who are independent lead a more active lifestyle however those less able or needing staff support, activities tend to be based around attendance at day services and local village amenities. There are six service users that live in Brandes Lodge, a converted barn at the rear of the main house. Two of the people live semi independently. They continue to lead an active lifestyle, one of them has a dog and takes it out regularly for walks. The other 6 people live in the main house and require more staff support. In one of the care files examined, there was an activities programme completed in a person centred format that was titled “My preferred daily routine”. This included likes/dislikes, interests/hobbies and includes information about playing pool. Tidying room, attending day services, arts class, pub visits and visits from relatives. Another care file examined was for a person that is currently in hospital and who had deteriorated significantly with their mobility, none of this was detailed in the plans and the activities plan had not been amended to reflect this change in needs. And in another care file examined it only stated that the person attends day services and college and visits from a relative and no other detail. We were informed that a lady comes into the home once week to take an Art class which people enjoyed. The people that take part in this class pay for it and their Art work has been mounted and is displayed in the home. The home continues to organises trips in the summer to Blackpool and Flamingo land, and that they hold birthday party’s and discos in the local village hall. They attend the Floral hall for musicals and people enjoy going to DS0000019742.V354273.R01.S.doc Version 5.2 Page 16 Mc Donalds. There is a large TV in the lounge and people enjoy film nights and there is also a pool table that they were observed using. Feedback from family and friends indicated that they are able to visit the home and can use any of the communal facilities or the persons bedroom. There is no restriction on visiting times. Staff assist people to maintain contact via mail and telephone. The majority of people have limited verbal communication to express their choices and wishes and promote their independence. Restrictions are not documented within all of files. The provision of meals was not assessed at this inspection, as it was satisfactory at the previous inspection. DS0000019742.V354273.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples health needs are generally met and the identification and recording of health needs and outcomes has improved however this is not the case for all of the people living in the home and means that health needs may not being fully met. EVIDENCE: At the previous inspection it was noted that plans relating to health needs and the recording of outcomes were of an unacceptably poor standard. This was accepted by managers of Milbury care services and since that inspection managers and staff have been working very hard to improve the quality of the paperwork and recording. However this has been hampered by the fact that half way through the process of transferring care files over to a new system, Milbury care brought in a new DS0000019742.V354273.R01.S.doc Version 5.2 Page 18 corporate format and all of the care plans had to be transferred yet again. In addition to this in June of this year the home suffered from extensive flooding when the region was hit by unprecedented amounts of rainfall. We were informed that out of twelve care files, two care files, service user plans and supporting documentation had been completed, one has been half completed and the remaining nine need to be completed. The community team learning disability have been approached to undertake health screening for all of the people that live in the home, in the meantime only two of the people had a detailed plan relating to health needs. These two were of a very good standard however this is not the case for all of the people that live in the home, therefore health needs are still not being clearly identified or planned for all of the people living in the home. Currently the local GP makes sure that service user medication reviews take place. There was evidence that staff do consult with health professionals i.e. GP, physiotherapy, dentist, chiropody and psychiatry etc, but although the recording had improved there was still improvements needed. This was discussed with the area manager who accepted the suggestions and agreed to implement them as soon as possible. At this visit the medication systems were not examined as they were found to be satisfactory at the previous visit. The senior staff had completed administration of medication training and have now had their competency assessed. Senior staff confirmed that they had completed epilepsy management training, which included the administration of rectal diazepam. Overall significant improvements were noted and this work must continue to ensure consistency across the service. DS0000019742.V354273.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints system and all of the staff are aware of their responsibility to protect people from the risk of harm, significant training has been provided for staff however increased staff numbers and the continued improvements in the quality of the plans and recording of outcomes will further safeguard the people that live in the home. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. There had been no complaints to the home since the previous inspection, Two of the people that live in the home present behaviour that may pose a risk to themselves and others and staff have now received training in how to manage people in times of distress and high anxiety. All of the staff have now received updated training in the Protection Of Vulnerable Adults (POVA). DS0000019742.V354273.R01.S.doc Version 5.2 Page 20 Overall significant improvements were noted and this work must continue to ensure consistency across the service and people continue to be protected from the risk of harm. DS0000019742.V354273.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment provides people with safe, comfortable and homely surroundings in which to live that meet their individual needs and lifestyles, EVIDENCE: The Granary is set in the village of Brandsburton a few miles from Driffield in the East Riding of Yorkshire. The village has pubs, a social club, church and parish hall, shops, hairdressers, bowls, football and cricket clubs. The accommodation comprises of two buildings, the main house and a converted barn, which has been named “Brandes Lodge”. The main house comprises of a large lounge, dining room, kitchen, staff office, two bathrooms, utility room and 6 bedrooms. DS0000019742.V354273.R01.S.doc Version 5.2 Page 22 Brands lodge consists of 6 bedrooms, kitchen, lounge, conservatory and a separate large activity room and managers office. All of the people that live in the home have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. In June of this year the home suffered from extensive flooding when the region was hit by unprecedented amounts of rainfall this has meant that new carpets have had to be been fitted in the entrance, lounge, stairs, hallway and dining room. Areas that were noted at the previous inspection as looking shabby have now been attended to or are planned to be. The upstairs landing has been wallpapered and some bedrooms have been decorated and re carpeted and others are in the planning. Brands Lodge in comparison to the main house still appears shabby in places some areas have been decorated but other areas still require redecoration. One of the people who lives in Brands Lodge told us that they would like their house redecorated. A requirement was made at the previous inspection to make good the windows in Brandes Lodge as there was paint peeling off and they look as if they need replacing, some of these have been replaced and we were told there is a programme to replace the others one a month. Outside the houses there is a lovely walled garden giving people the opportunity to sit outside and still have privacy when the weather permits. Overall significant improvements were noted and this work must continue to ensure consistency across the service. DS0000019742.V354273.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The current staffing arrangements/numbers are not sufficient to meet the needs of the people that live in the home and further service specific training needs to be provided. EVIDENCE: It was noted at the previous inspection “The inspector was informed that the home has 16 staff in total, comprising of • • • • 1x 3x 6x 6x Registered manager senior support workers day support workers night support workers The rota evidenced that there are 3.5 support workers allocated per day shift, .5 of this is the registered manager and 1 x staff is the senior support worker, DS0000019742.V354273.R01.S.doc Version 5.2 Page 24 leaving only 2 x support workers to attend the needs of 10 people (2 people being reasonably independent but need some guidance and support). Staff have the responsibility of cleaning 12 bedrooms, 8 bathrooms and all communal areas, the preparation, cooking and serving and cleaning up after 3 meals per day, supporting people to attend appointments, activities, undertake shopping and gardening and in addition to this attend to the care needs of people.” This has not changed since the previous inspection however consideration has now been given as to whether the home is sufficiently resourced to meet everyone’s needs. All of the people that live in the home are in the process of being re assessed/reviewed by the placing local authority to ensure that the home can still meet their needs and that the funding is correct and the right amount of staff can be provided to meet peoples changing needs. We were also informed that both of the people who are currently in the hospital will be re assessed prior to them coming home to ensure that the home can continue to met their changing needs. The people who live in the home say they are very happy living there, ten people completed the CSCI questionnaire and there were no negative comments about the home, one commented “I ask staff to help me” and another stated “I like being here, I enjoy living here lots of friends including staff” and another said “I keep my house clean”. Comments received from visiting professionals included “the two people I placed were made in an emergency however staff did everything possible to gather as much information as possible prior to admission to ensure they could meet the individual needs” , “ if there are difficulties with an individual they (staff) readily seek advice and support from other professionals” “a very good service” And a relative commented “as long as the staff remain as caring as at present I would find it difficult to suggest any improvements” and another stated “my son is happy there, he gets on well with all staff members” and another said “they care for my son extremely well and I can only praise them for the care the give”. 4 staff files and the training records were examined in the course of the inspection, 3 of these being new starters. All had completed application forms, had 2 satisfactory references and CRB clearances prior to commencing employment. The three new staff had now completed their probationary interviews and induction. The senior member of staff responsible for monitoring training has a good understanding of what training has been provided and what still needs to DS0000019742.V354273.R01.S.doc Version 5.2 Page 25 happen in respect of training. Most staff are now up to date with their basic training, staff that needed it have completed induction training, all of the staff who give people medication have all received training and have been assessed as competent by the home manager and some special training has been provided and more is planned. The home had a training plan and 1 x senior support worker has NVQ level 3 and 1 x senior support worker and 3 support workers have NVQ level 2. The remaining staff need to be registered and working towards their NVQ level 2 to ensure that the home can meet the requirement of 50 . Some of the people that live in the home have presenting needs in communication deficits, autism, sensory impairments and present behaviours that may pose a risk to themselves or others, the majority of staff have completed training in autism and some have done basic signing, two staff have completed training in how to manage difficult behaviour. This attention to service specific training needs to continue to ensure all staff have the skills and competence to meet peoples needs. Staff records examined evidenced that supervision is provided sufficiently to ensure staff are adequately supported. In addition to this staff had received appraisal interviews. The registered person is still required to increase the care staff hours provided in the home to ensure that they can meet the complex needs of the people that live there and to ensure that at least 50 of staff are qualified to NVQ level 2. The registered person is also required to ensure that service specific training is continued to be provided in autism, effective communication skills, managing behaviour that may pose a risk to themselves or others, equality and diversity, values and attitudes and effective recording. Overall significant improvements were noted and this work must continue to ensure consistency across the service. DS0000019742.V354273.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Significant improvements have been made since the previous inspection and people live in a safe and comfortable environment and in general their needs are met however progress needs to continue in improving the standards in the home. EVIDENCE: The Granary is part of Milbury Care Services which is a national provider of care and support services for people with a learning disability. Milbury is part of the Paragon Health Care group, which is a UK wide organisation that specialises in providing a range of services to vulnerable people. DS0000019742.V354273.R01.S.doc Version 5.2 Page 27 The registered manager of the service has over 25 years experience in the field of learning disabilities and has been in post since May 2006. She has degree in social sciences and informed the inspector that she will commence her NVQ level 4 and registered managers award this year. The manager is registered with the CSCI. Milbury care services and CSCI have been working closely together and meeting regularly to review progress and it was noted at this inspection that significant improvements have been made. Managers and staff have worked very hard to improve standards in the home and to meet or partially meet the requirements made at the previous inspection. Overall significant improvements were noted in the developments of service user plans and supporting documentation, recording of outcomes, training and the update of the environment. In addition to this all of the people that live in the home are in the process of being re assessed/reviewed by the placing local authority to ensure that the home can still meet their needs and that the funding is correct and the right amount of staff can be provided to meet peoples changing needs. We were also informed that both of the people who are currently in the hospital will be re assessed prior to them coming home to ensure that the home can continue to met their changing needs. All of these developments must continue to ensure consistency across the service and to ensure that people continue to be protected from the risk of harm. Staff have meetings with the managers on a regular basis and everyone is encouraged to join in with discussions and voice their opinions. At the previous inspection all maintenance records were examined and were satisfactory apart from Legionella – the home had file however no tests had been undertaken for over a year, the manager has raised this with H/Q. this has now been addressed and all remedial works carried out. Milbury care services have a QA system, which includes regular audits and monitoring of the service culminating in an annual service review. The area manager undertakes regulation 26 visit on a monthly basis, this and the QA monitoring and checking process has highlighted the areas for improvement and the CSCI are satisfied that the home will make progress to ensure all requirements are met within the timescales specified. DS0000019742.V354273.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 x 4 2 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 2 15 x 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x 2 x 3 x x 3 x DS0000019742.V354273.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement The registered person must ensure that the assessment of people is kept under review and people must not be admitted if the home is unable to meet their assessed needs. (Timescale of 30/06/07 not met) The registered person must ensure that people admitted in an emergency have an up to date service user plan and risk assessments within 5 days of admission. (Timescale of 30/06/07 not met) The registered person must ensure that the development of plans continues and must detail the action to be taken by staff to meet their personal, health and welfare needs. (Timescale of 31/08/07 not met) The registered person must ensure that the development of individual and generic risk assessments continues and that they are maintained and reviewed. (Timescale of 31/08/07 not met) The Registered person must ensure that educational DS0000019742.V354273.R01.S.doc Timescale for action 28/02/08 2. YA4 13, 15 28/02/08 3. YA6 15 and 17 28/02/08 4. YA9 13 and 17 28/02/08 5. YA12 16 (2 m and n) 28/02/08 Version 5.2 Page 30 6 YA14 16 (2 m and n) 7 YA19 13 8 YA24 23 9 YA32 18 10 YA33 18 opportunities are identified, planned for and provided that meet the diverse needs of the people and meet their assessed needs. These must be incorporated into their plan. (Timescale of 31/08/07 not met) The Registered person must ensure that leisure activities are identified, planned for and provided that meet the diverse needs of people and meet their assessed needs. These must be incorporated into their plan. (Timescale of 31/08/07 not met) The registered person must ensure that peoples complex health needs are met by the provision of health screening, health action plans and access to health professionals. (Timescale of 31/08/07 not met) The registered person must provide a written maintenance and renewal plan with timescales for the redecoration of the interior of the house and the renewal or repair and painting of the windows in the barn. (Timescale of 28/02/06 and 30/06/07 not met) The registered person must ensure that staff receive specialised training in meeting the complex needs of people with a learning disability;Communication skills How to deal with people that present with difficult behaviour Equality and diversity (Timescale of 31/08/07 not met) The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to support peoples assessed needs at all times. Staffing levels must be regularly reviewed to reflect DS0000019742.V354273.R01.S.doc 28/02/08 28/02/08 28/02/08 28/02/08 28/02/08 Version 5.2 Page 31 11 YA37 8 peoples changing needs. (Timescale of 31/08/07 not met) The registered person must ensure that the home is managed effectively. Policies and procedures are implemented and that compliance with the care standards act, regulations and other legal requirements are adhered to. (Timescale of 30/06/07 not met) 28/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA37 YA32 Good Practice Recommendations The registered person should ensure that the registered manager is qualified to NVQ level 4 and completes the registered managers award. The registered person must ensure that at least 50 of staff are qualified to NVQ level 2 DS0000019742.V354273.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000019742.V354273.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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